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Chapter 10 pt1
Hepatitis
88
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Professional
03/06/2013

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Term
What is hepatitis?
Definition
inflammation of the liver that can be caused from infections or other causes
Term
What are some things caused by infections?
Definition
causes include viral hepatitis and infections associated with infectious mononucleosis, secondary syphilis, and tuberculosis
Term
What can noninfectious hepatitis result from?
Definition
can result from excessive, prolonged use of toxic substances, such as drugs (e.g., acetaminophen, halothane, ketoconazole, methyldopa, and methotrexate) or, more commonly, alcohol
Term
Which hepatitis viruses are viral?
Definition
Hepatitis A, B, and C
Term
Is chronic viral hepatitis deadly?
Definition
yes, causes liver cancer and cirrhosis
Term
Are the symptoms of the different hepatitus viruses different? How are the differentiated?
Definition
-all very similar
-differentiated with serologic assays
Term
What are hepatitius A and E?
Definition
-forms of infectious hepatitis
-they are spread by the fecal-oral route
-associated with poor sanitary conditions
-are highly contagious, occur in outbreaks as well as sporadically -cause self-limited hepatitis only
Term
What are hepatitis B, C, and D?
Definition
-forms of serum hepatitis
-spread largely by parenteral routes and less commonly by intimate or sexual exposure
-not highly contagious, but instead occur sporadically, rarely cause outbreaks
-are capable of leading to chronic infection and, ultimately, to cirrhosis and hepatocellular carcinoma
Term
What causes Non A-E? (acute viral hepatitis)
Definition
the viral etiology is unknown
Term
What causes liver injury in hepatitis?
Definition
the immune system respose
Term
What is recovery from the hepatitis virus accompanied by?
Definition
a titer of antibodies
Term
What is the incubation of viral acute hepatitis?
Definition
2-20 weeks
Term
What is the preicteric phase of illness marked by?
Definition
the onset of nonspecific symptoms, such as fatigue, nausea, poor appetite, and vague right upper quadrant pain
Term
When are viral titers generally highest? What starts to increase at this point?
Definition
during the first phase of disease, serum aminotransferase levels start to increase
Term
What determines the icteric phase of illness?
Definition
-onset of dark urine
-jaundice
-fatiue and nausea worsens
Term
If jaundice is severe, stool color BLANK due to pruritus.
Definition
if jaundice is severe, stool is lighter
Term
What are the serum bilirubin levels like? What are the aminotransferase levels like?
Definition
-Serum bilirubin levels (total and direct) rise
-aminotransferase levels generally are higher than 10 times the upper limit of normal, at least at the onset
Term
What do the levels of hepatitis do as a reult of this?
Definition
levels lower in liver and serum
Term
how long does clinical illness last? What is recovery first marked by?
Definition
-1-3 weeks
-return of apatite
Term
What are some complications of acute viral hepatitis?
Definition
-Chronic infection
-Fulminant hepatic failure
-Relapsing or cholestatic hepatitis
-Extrahepatic syndromes
Term
Does chronic hepatitis always develop with Hepatitis B and C?
Definition
B-very rare
C-50-85%
Term
What is the serum sickness seen with acute hepatitis?
Definition
combinations of rash, hives, arthralgias, and fever develops during the preicteric phase
-often attributed to other illnesses
Term
What are used to diagnose viral hepatitis?
Definition
serologic tests, liver biopsy not recommended
Term
What are some treatments for hepatitis?
Definition
-bed rest
-no alcohol
-no sexual contact
Term
What should all household be given with a case of Hep A?
Definition
given immune globulin, and initiation of HAV vaccination is appropriate
Term
What should family members get with a case of Hep B? What about sexual contacts?
Definition
should be vaccinated, and hepatitis B immune globulin (HBIG) also should be given to recent sexual contacts
Term
Hepatitis A-
1.Epidemiology
2.Pathophysiology
3.Clinical manifestations
4.Diagnosis
5.Prevention
6.Treatment
7.Prognosis
Definition
1.Epidemiology-fecal oral, contagious
2.Pathophysiology-small RNA virus, Picornaviridae (genus Hapatovirus)
3.Clinical manifestations-incubation 15 to 45 days, jaundice, antibody seen, severe cases in older and ppl with liver disesse
4.Diagnosis-IgM anti-HAV in the serum
5.Prevention-vaccine in 1 or older, reccomended for those at risk
6.Treatment-none, people around infected should get vaccine
7.Prognosis-can persist, but self limiting and cannot progress to chronic illness
Term
Is Testing for total anti-HAV helpful in diagnosis?
Definition
no, but is can be used to assess immunity in hep A
Term
Hepatitis B-
1.Epidemiology
2.Pathophysiology
3.Clinical manifestations
4.Diagnosis
5.Prevention
6.Treatment
7.Prognosis
Definition
1.Epidemiology-the parenteral route or by intimate personal contact
2.Pathophysiology-double-shelled, enveloped DNA virus belonging to the family Hepadnaviridae (genus Orthohepadnavirus)
3.Clinical manifestations-30-150 days incubation, HBV levels fall at onset of symptoms, Anti-HBs is the long lasting immunity
4.Diagnosis-HBsAg in the serum in blood, Testing for IgM anti-HBc because it arises early,can cause fulminant hep
5.Prevention-vaccine for everyone,3 injections, A single dose of HBIG and virus given to exposed person(,14 days) and vaccine for exposure by sex
6.Treatment-interferon alfa and lamivudine for chronic, for acute they should avoid further hepatic injury, and prophylaxis of contacts
7.Prognosis-rarely develops into chronic except in babies and immunocompromised people, chronic commonly leads to cirohis and liver cancer
Term
People who remain HBV DNA or HBeAg positive (or both) at 6 weeks after the onset of symptoms are likely to be developing...
Definition
chronic hep B
Term
Hepatitis C-
1.Epidemiology
2.Pathophysiology
3.Clinical manifestations
4.Diagnosis
5.Prevention
6.Treatment
7.Prognosis
Definition
1.Epidemiology-parenteral(needle drug use most common)
2.Pathophysiology-RNA virus that belongs to the family Flaviviridae (genus Hepacivirus), detectable in serum in titers of 105 to 107 virions/mL during acute and chronic
3.Clinical manifestations-incubation 15-120 days
4.Diagnosis-detection of anti-HCV in serum
5.Prevention-avoid high risk behaviors
6.Treatment-peginterferon alfa and ribavirin(in chronic), acute cases sometimes treated with these because so many end up leading to chronic
7.Prognosis-50-85% of cases become chronic
Term
Hepatitis D-
1.Epidemiology
2.Pathophysiology
3.Clinical manifestations
4.Diagnosis
5.Prevention
6.Treatment
7.Prognosis
Definition
1.Epidemiology-linked to hepatitis B, and, consequently, its epidemiology is similar, parenteral and sexual, pts w/blood disorders
2.Pathophysiology-delta virus is a unique RNA virus that requires HBV for replication
3.Clinical manifestations-coinfection (HBV AND HDV) and superinfection (acute HDV with chronic HBV) 4.Diagnosis-superinfection(acute symptoms already diagnosed with chronic HBV), much more common than coinfection
5.Prevention-prevent hep B.
6.Treatment-Most cases of acute coinfection resolve
7.Prognosis- likely to lead to fulminant hepatitis, chronic hep, and cirrhosis
Term
Hepatitis E-
1.Epidemiology
2.Pathophysiology
3.Clinical manifestations
4.Diagnosis
5.Prevention
6.Treatment
7.Prognosis
Definition
1.Epidemiology-responsible for epidemic and endemic forms of non-A, non-B hepatitis that occur in less-developed areas of the world, fecal-oral and through water
2.Pathophysiology-HEV is a small, nonenveloped, single-stranded RNA virus that is currently unclassified
3.Clinical manifestations-clinical course of hepatitis E resembles that of other forms of hepatitis
4.Diagnosis-Detection of anti-HEV, particularly of the IgM subclass, is sufficient to make the diagnosis
5.Prevention-There are no known means of prevention or treatment of hepatitis E
6.Treatment-none
7.Prognosis-
Term
What may someone with symptoms of hep be tested for sometimes?
Definition
secondary syphilis
Term
Presence of fever and atypical lymphocytosis points to..
Definition
mononucleosis
Term
The presence of hemolysis should suggest...
Definition
Wilson disease
Term
Hepatitis Non A-E
1.Epidemiology and pathobiology
2.Clinical manifestations
3.Diagnosis
4.Treatment
5.Prognosis
Definition
1.Epidemiology and pathobiology-that appear to be viral in etiology but cannot be attributed to any known cause are called hepatitis non-A-E
2.Clinical manifestations-similar to those of recognized forms of acute hepatitis, no clear exposure source
3.Diagnosis-a diagnosis of exclusion
4.Treatment-There is no means of either treatment or prevention of non-A-E hepatitis
5.Prognosis-associated with the complications of acute liver failure and aplastic anemia
Term
Which types of hepatitis have little or no occupational risk?
Definition
HAV, HEV, and non-A-E hepatitis viruses
Term
Which form of hepatitis is the greatest occupational exposure risk?
Definition
Hepatitis B virus is most dangerous, hep C is less dangerous
Term
How long can HBV survive in dry blood?
Definition
at least 1 week
Term
Does the role of saliva in HBV or HCV transmission, except by percutaneous or permucosal routes appear to be significant?
Definition
No
Term
What are some of the complications of hepatitis?
Definition
Icterus (jaundice), the accumulation of bilirubin in the plasma, epithelium, and urine
Term
What is bilirubin? How is it transported to the liver?
Definition
-a degradation product of hemoglobin and one of the major constituents of bile
-normally is transported to the liver by way of the plasma
Term
What happens t bilirubin in the liver?
Definition
it conjugates with glucuronic acid, and then it is excreted into the intestine, where it aids in the emulsification of fats and stimulates peristalsis
Term
In the presence of liver disease, bilirubin tends to...
Definition
accumulate in the plasma as a consequence of decreased liver metabolism and transport
Term
When does jaundice become apparent?
Definition
when the plasma level of bilirubin approaches 2.5 mg/100 mL
Term
What does it mean if the patient is anicteric?
Definition
without jaundice
Term
Most cases of viral hepatitis, especially types A and E...
Definition
resolve without any complications
Term
HBCDV do what?
Definition
can persist and replicate in the liver when the virus is not completely cleared from the organ
Term
What are some potential outcomes of hepatitis?
Definition
-recovery
-persistent infection
-dual infection
-chronic active hepatitis
-fulminant hepatitis
-cirrhosis
-hepatocellular carcinoma
-death
Term
What is Fulminant Hepatitis?
Definition
A serious complication of acute viral hepatitis
Term
What is fulminant hep characterized by?
Definition
characterized by massive hepatocellular destruction and a mortality rate of approximately 80%
Term
Who does fulminant hep occur in?
Definition
occurs more commonly among elderly persons and patients with chronic liver disease
Term
What can cause Fulmiant Hep?
Definition
Coinfection or superinfection with HBV and HDV, or infection by a single hepatitis virus
Term
What is chronic infection characterized by?
Definition
by the persistence of low levels of virus in the liver and serum viral antigens (HBsAg, HBeAg, and HCVAg) for longer than 6 months without signs of overt disease
Term
Are patients with chronic infection infectious to others?
Definition
potentially
Term
The rate of carrier establishment varies depending on...
Definition
the virus and the age and health of the patient
Term
What is the carrier rate of dentists like?
Definition
3 to 10 times than that of the general population
-highest with hemophilia patients and drug users
Term
What may the carrier state do?
Definition
-stay the same or progress to chronic active
Term
What can chronic HBV and HCV cause?
Definition
hepatocellular carcinoma(liver cancer)
Term
After the incubation phase, how many of each virus is asymptomatic?
Definition
10% of hepatitis A
60% to 70% of hepatitis C
70% to 90% of hepatitis B cases are asymptomatic
Term
WHat are many of the signs and symptoms in hepatitis like?
Definition
a normal virus, flu like
Term
What are the three phases of acute illness?
Definition
1.The prodromal (preicteric) phase- usually precedes the onset of jaundice by 1 or 2 weeks and consists of abdominal pain, anorexia, intermittent nausea, vomiting, fatigue, myalgia, malaise, and fever
2.The icteric phase is heralded by the onset of clinical jaundice, manifested by a yellow-brown cast to the conjunctivae, skin, oral mucosa, and urine
3.Convalescent or recovery (posticteric) phase, symptoms disappear, but hepatomegaly and abnormal liver function values may persist for a variable period
Term
How quickly after jaundice does the sequence of recovery appear?
Definition
about 4 months
Term
What are the standard tests in assessing for liver disease?
Definition
determinations of total and direct bilirubin, albumin, prothrombin time, and the serum enzymes ALT, AST, and alkaline phosphatase
Term
What are the most sensitive markers of acute hepatocellular injury, have been used to identify liver disease since the 1950s?
Definition
The serum aminotransferases (also called transaminases)
Term
Alkaline phosphatase applies generally to...
Definition
a group of isoenzymes distributed widely throughout the body
Term
What does Hepatobiliary disease lead to?
Definition
to increased serum alkaline phosphatase levels through induced synthesis of the enzyme and leakage into the serum, a process mediated by bile acids
Term
The risk of viral hepatitis is reduced by receiving...
Definition
-active immunization
(HABV both have 2)
Term
What is Twinrix?
Definition
vaccine available for combination hepatitis A and B
Term
Comvax
Definition
vaccine available for hepatitis B and Haemophilus influenzae type b (in combination with Neisseria meningitidis OMPC) in infants
Term
Harivax and Vaqta are formalin-inactivated whole virus vaccines used specifically to prevent...
Definition
HAV
**safe, works well, reccomended for patients 2 and older**
Term
(Engerix-B and Recombivax B) are produced by recombinant DNA technology
Definition
2 vaccines for HBV, 3 vaccines, over 6 month period, produce effective antibody response in most
Term
How long does immunity remain effective?
Definition
over 10 years, no current booster recommended
Term
Who gets HBV vaccines?
Definition
people that are exposed to it
Term
Treatment of viral hepatitis can be accomplished by administering...
Definition
early postexposure immune globulins or postexposure hepatitis B vaccine
Term
Chronic hepatitis BLANK resolves spontaneously.
Definition
Chronic hepatitis rarely resolves spontaneously.
Term
Who are corticosteriods usually reserved for? Liver transplantation?
Definition
-people with filminant hepatitis
-cirrhosis
Term
All patients with a history of viral hepatitis must be managed as though they are...
Definition
potentially infectious
Term
Should we treat a patient with active hepatitis?
Definition
no
Term
Any patient who has signs or symptoms suggestive of hepatitis...
Definition
should not receive elective dental treatment, med con
Term
What should we do if the patient has chronic active hepatitis, however, or is a carrier of HBsAg or HCV and has impaired liver function?
Definition
the dosage for drugs metabolized by the liver should be decreased, or such drugs avoided if possible
Term
What may someone with liver damage have?
Definition
abnormal bleeding
Term
Persons with fulminant hepatitis...
Definition
should be referred early for possible liver transplantation
Term
What are the long lasting antibodies for Heptitis B? Short?
Definition
Long-Anti-HBs
Short-HBsAG
Term
What is the suggestion for hepatits b injections?
Definition
3 injections given in deltoid muscle at 0, 1, and 6 months
Term
What should be given right after an occupational exposure to hepatitis b?
Definition
HBIG(if exposure is <14 days) and then the vaccines
Term
WHat causes Icterus (jaundice)?
Definition
the accumulation of bilirubin in the plasma, epithelium, and urine
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